Stable and Unstable Angina: What’s the Difference?

Medically Reviewed by Carolin Schneider, MD

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You might have heard that stable and unstable angina can have serious health risks, but the difference between them is unclear — and difficult to guess from their names alone. Angina is often a symptom of one of the most common types of heart disease in adults: coronary heart disease (CHD). The two types of angina have quite a few differences, and knowing more about these is essential for understanding how much this symptom might impact your health.

What Determines Whether Angina Is Stable or Unstable?

Angina is not a condition. It’s a common symptom of an underlying heart condition (usually CHD). Angina is a feeling of chest pain or discomfort that happens when an area of your heart isn’t getting enough oxygen-rich blood. The pain may spread to your left arm, neck, lower jaw, upper abdomen or even your back. You might feel restlessness and show symptoms of fear, too.

Stable angina usually occurs when your heart is working harder than usual. This could be due to exercising, eating a large meal, going out in cold weather or feeling emotional stress. These states are all triggers for stable angina. The discomfort of a stable angina attack fades typically after a few minutes of rest or after taking a medication your doctor has prescribed you for angina. The majority of stable angina attacks last for one to 15 minutes.

An unstable angina attack can happen at any time, even when you’re at rest. It may appear with or without physical exertion. Unstable angina attacks tend to be more powerful. Resting or taking angina medicine doesn’t lessen the pain linked to an unstable angina attack, which regularly lasts longer than 15 minutes. You should seek emergency treatment immediately because unstable angina may indicate that a heart attack may happen soon.

Common Risk Factors for Stable and Unstable Angina

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Stable and unstable angina share many of the same risk factors. These include the following:

  • Obesity
  • Smoking
  • Being male
  • Lack of exercise
  • Diabetes mellitus
  • High blood pressure
  • Family history of CHD before age 50
  • High LDL cholesterol and low HDL cholesterol

In addition, older age increases the risk of developing unstable angina. Although CHD is usually the cause of angina attacks, other conditions can cause CHD, including:

  • Hypertrophic cardiomyopathy
  • Pulmonary embolism
  • Aortic dissection
  • Pericarditis

How to Tell Which Type You Have

If you feel chest pain or discomfort, you may wonder whether you have stable or unstable angina. The following symptoms point to stable angina:

  • Pain relieved by rest or medication
  • Pain beginning slowly and getting worse over the next few minutes
  • Attacks occurring during periods of exertion (exercise, stress and similar activities)
  • Tightness, tension or pressing feeling in your chest, which may spread to other areas of your torso, neck and jaw

You may also experience other possible symptoms, such as:

  • Pain
  • Nausea
  • Vomiting
  • Dizziness
  • Light-headedness
  • Shortness of breath
  • Feeling of indigestion or heartburn

The following symptoms point to unstable angina:

  • Tightness, burning, squeezing or aching feeling in your chest, which may spread to other areas of your torso, neck and jaw
  • Attacks that occur randomly, with or without exertion
  • Pain that occurs suddenly and feels severe
  • Pain not relieved by rest or medication

Other potential signs of unstable angina include:

  • Sweating
  • Shortness of breath
  • A drop in blood pressure

Keep in mind that, if you have stable angina, you may start to develop unstable angina over time. Pay close attention to the timing and severity of your stable angina attacks. If they start to get worse and happen more suddenly, you may be developing unstable angina.

Treatment Options for Stable and Unstable Angina

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Any chest pain needs treatment right away. Get medical assistance immediately if you feel significant pain or discomfort in your chest.

Stable angina

For stable angina, initial treatment may lead to a doctor giving you advice on how to live a healthier lifestyle and maybe prescribing medication to help treat future episodes of angina. A healthcare provider will likely suggest lifestyle changes to improve your heart health overall. In some cases, you may need surgery to fix a blockage or narrowing in your arteries.

After a diagnosis, you may be able to deal with stable angina attacks on your own. However, it’s critical to speak with your doctor about recognizing signs of a heart attack. In addition, you should discuss when you should call 911 rather than trying to deal with an attack on your own. In many cases, stable angina improves with medication and especially with lifestyle changes.

Unstable angina

Unstable angina attacks are much more severe and require immediate medical attention. Call 911 for emergency treatment; you’ll most likely be taken to the hospital. Once the attack subsides, a doctor may prescribe medications, lifestyle changes or surgeries to improve your heart health. You may treat future attacks with nitroglycerin, but immediate medical treatment is necessary if the medication doesn’t take effect within a few minutes. Unstable angina attacks are a sign of more severe heart disease, and they may lead to abnormal heart rhythms, a heart attack or even heart failure.

Taking care of your health now is the best way to prevent stable and unstable angina. If you currently experience one of these conditions, be sure that you’re fully aware of the symptoms of a heart attack and see your doctor regularly to monitor your heart health.

Resource Links:

Unstable Angina,” National Library of Medicine

Coronary Artery Disease Prevention,” National Library of Medicine

Angina,” National Library of Medicine

Treatment of Angina: Where Are We?,” National Library of Medicine

Stable Angina,” National Library of Medicine